- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,271.30 / $27,520.00 / $35,931.19
| Facility | | $13,271.30 | $27,520.00 | $35,931.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,806.77 / $67,296.89
| Facility | | $5,840.42 | $24,806.77 | $67,296.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,549.69 / $25,711.76 / $38,850.76
| Facility | | $15,549.69 | $25,711.76 | $38,850.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,513.33 / $36,513.33 / $36,513.33
| Facility | | $36,513.33 | $36,513.33 | $36,513.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,404.07 / $25,902.28 / $39,999.19
| Facility | | $22,404.07 | $25,902.28 | $39,999.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $24,806.77 / $67,296.89
| Facility | | $5,840.42 | $24,806.77 | $67,296.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,544.46 / $52,593.11
| Facility | | $5,840.42 | $19,544.46 | $52,593.11 |